What question did this study set out to answer?

To examine variations in patient case-mix, organizational structure, resource consumption, and risk-adjusted clinical performance between teaching and nonteaching intensive care units.

October 1, 1993Critical Care Medicine

Value and cost of teaching hospitals

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Authors

JZJack E. ZimmermanLinköping University SSStephen M. ShortellBerkeley Public Health Division WKWilliam A. KnausLinköping University

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Implication

Prospective cohort study reveals higher resource use but superior survival in major teaching ICUs among critically ill patients, highlighting trade-offs between care costs and clinical performance.

Key Points

To examine variations in patient case-mix, organizational structure, resource consumption, and risk-adjusted clinical performance between teaching and nonteaching intensive care units.
Prospective inception cohort study of consecutive admissions across 35 hospitals (N=15,297), comparing 8,269 patients across 20 teaching ICUs (18 hospitals) against 7,028 patients across 17 nonteaching ICUs (17 hospitals).
Collected demographic, physiological, treatment, and structural data (averaging 415 patients per ICU) to compute observed-to-predicted ratios for hospital mortality, length of stay, and resource utilization.
Teaching ICUs cared for significantly younger and more severely ill patients (p < .001) and used significantly more resources (p < .001), averaging $3,000 (10.5%) higher costs per admission driven by diagnostic testing and invasive procedures, despite similar risk-adjusted length of stay.
Overall risk-adjusted hospital death rates did not differ significantly between all teaching and nonteaching ICUs (p = .1), although four teaching ICUs versus one nonteaching ICU achieved significantly better survival (p < .05).
Council of Teaching Hospitals member institutions (16 ICUs across 14 hospitals) demonstrated significantly superior risk-adjusted outcomes compared with all other ICUs (OR = 1.21, 95% CI 1.06 to 1.38, p = .004).

Cite This Study

Zimmerman et al. (1993) studied this question.

synapsesocial.com/papers/6a0385ca449d02b60985f882 https://doi.org/10.1097/00003246-199310000-00009

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Implication

Prospective cohort study reveals higher resource use but superior survival in major teaching ICUs among critically ill patients, highlighting trade-offs between care costs and clinical performance.

Value and cost of teaching hospitals

Discussion

Member takes

Implication

Key Points

Cite This Study

Value and cost of teaching hospitals

Discussion

Member takes

Implication

Key Points

Cite This Study

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